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Psychoeducation As a Mediator of Treatment Approach on Parent Engagement in Child Psychotherapy for Disruptive Behavior

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Psychoeducation As a Mediator of Treatment Approach on Parent Engagement in Child Psychotherapy for Disruptive Behavior Journal of Clinical Child & Adolescent Psychology ISSN: 1537-4416 (Print) 1537-4424 (Online) Journal homepage: http://www.tandfonline.com/loi/hcap20 Psychoeducation as a Mediator of Treatment Approach on Parent Engagement in Child Psychotherapy for Disruptive Behavior Jonathan I. Martinez, Anna S. Lau, Bruce F. Chorpita, John R. Weisz & Research Network on Youth Mental Health To cite this article: Jonathan I. Martinez, Anna S. Lau, Bruce F. Chorpita, John R. Weisz & Research Network on Youth Mental Health (2015): Psychoeducation as a Mediator of Treatment Approach on Parent Engagement in Child Psychotherapy for Disruptive Behavior, Journal of Clinical Child & Adolescent Psychology, DOI: 10.1080/15374416.2015.1038826 To link to this article: http://dx.doi.org/10.1080/15374416.2015.1038826 Published online: 04 Jun 2015. Submit your article to this journal Article views: 207 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hcap20 Download by: [Smithsonian Astrophysics Observatory] Date: 24 August 2016, At: 13:47 Journal of Clinical Child & Adolescent Psychology, 0(0), 1–15, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 1537-4416 print=1537-4424 online DOI: 10.1080/15374416.2015.1038826 Psychoeducation as a Mediator of Treatment Approach on Parent Engagement in Child Psychotherapy for Disruptive Behavior Jonathan I. Martinez Department of Psychology, University of California, Los Angeles Child & Adolescent Services Research Center Anna S. Lau and Bruce F. Chorpita Department of Psychology, University of California, Los Angeles John R. Weisz Department of Psychology, Harvard University Research Network on Youth Mental Health Chicago, Illinois Parent engagement in treatment for child disruptive behavior has been associated with improved child outcomes in care. However, many families who enter care do not receive an adequate dose of treatment, and parents are often not involved. We examined therapists’ use of psychoeducation, a therapeutic practice used to present factual information about target problems and treatments, and its association with parent engagement in child psycho- therapy. Participants were drawn from the Child System and Treatment Enhancement Projects’ multisite trial contrasting standard evidence-based treatments, modular treatment, or usual care. We included an ethnically diverse sample of 46 youth (ages 7–13) who received treatment for disruptive behavior in modular treatment or usual care. A reliable observa- tional coding system was developed to assess therapists’ in-session use of psychoeducation strategies (e.g., discussing causes of misbehavior, describing and providing rationale for treatment, etc.), as well as other engagement strategies (e.g., collaborative goal setting, man- aging expectations, etc.), in the early phase of treatment. Findings revealed that modular treatment therapists provided more psychoeducation and other engagement strategies com- pared with usual care therapists. Furthermore, psychoeducation strategies employed by therapists early on uniquely predicted subsequent parent involvement in treatment, over and above the use of other engagement strategies. Finally, therapists’ use of the psychoedu- cation strategy of discussing causes of child’s misbehavior mediated the effect of treatment condition on parent involvement in their child’s therapy. These findings suggest that the implementation of psychoeducation strategies upon entry into care promotes parent involvement in child psychotherapy for disruptive behavior. During the time of this study, the Research Network on Youth Mental Health included Bruce F. Chorpita, Ann Garland, Robert Gibbons, Charles Glisson, Evelyn Polk Green, Kimberly Hoagwood, Kelly Kelleher, John Landsverk, Stephen Mayberg, Jeanne Miranda, Lawrence A. Palinkas, Sonja K. Schoenwald, and John R. Weisz (Network Director). The Modular Approach to Treatment of Children With Anxiety, Depression, or Conduct Problems (MATCH) manual used in this study was a precursor to a revised and expanded version for which Bruce F. Chorpita and John R. Weisz receive income. Correspondence should be addressed to Jonathan I. Martinez, Department of Psychology, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330-8255. E-mail: [email protected] 2 MARTINEZ ET AL. In recent decades, there have been important advances Kim, & Quintana, 2002). Parents are more likely to drop in the child mental health (MH) care evidence base, out of services if they have a mismatch of treatment including an understanding of the etiology of child expectations with the therapist, such as how much MH problems, as well as the proliferation of evidence- parents need to be involved in their child’s treatment based interventions for those problems (National (Flisher et al., 1997; Nock, Ferriter, & Holmberg, 2007; Research Council and Institute of Medicine, 2009). Nock & Kazdin, 2005). One study found that parents’ Randomized controlled trials demonstrate that child perception of treatment relevance for their child’s prob- therapies are efficacious (National Research Council lems was the factor that best discriminated treatment and Institute of Medicine, 2009; Weisz & Kazdin, dropouts from completers (Morrissey-Kane & Prinz, 2010). However, as many as 75–80% of U.S. youth 1999). For ethnic minority and socially disadvantaged in need do not receive MH services (MHS), with the families, unpacking gaps in MH literacy may be critical disparity in need and service use highest among racial= for engaging parents. For example, addressing parent ethnic minority and socially disadvantaged families beliefs about MHS at treatment outset was associated (Kataoka, Zhang, & Wells, 2002). Among families with increased parent engagement in care in a sample who initiate services, more than 50% fail to complete of low-income, predominantly ethnic minority youth treatment (Kazdin, 1996). In fact, the majority of and their families (McKay, Nudelman, McCadam, & families who enter care attend only a small number of Gonzales, 1996; McKay, Stoewe, McCadam, & Gonzales, sessions insufficient to receive an adequate dose of treat- 1998). A qualitative study with Mexican American ment (Armbruster & Fallon, 1994; Harpaz-Rotem, parents found that most parents initiating child MHS Leslie, & Rosencheck, 2004). Thus, despite significant experienced disapproval from family who felt there was advances in developing evidenced-based interventions no MH problem or were skeptical of treatment and for child MH problems, they are limited in impact due expressed that Latinos were less likely to receive MHS to a lack of family engagement in services. because of a lack of knowledge about effective treat- In child psychotherapy, parents’ active involvement ments. In addition, parents were more likely to drop in treatment is considered critical to achieving successful out if they endorsed unrealistic beliefs and expectations outcomes (Nock & Kazdin, 2005), with children faring for child therapy (McCabe, 2002). better when parents are actively involved relative to In child psychotherapy, presenting factual infor- individual child treatment (Dowell & Ogles, 2010; mation to parents about their child’s MH problems Karver, Handelsman, Fields, & Bickman, 2006). One and effective treatments is commonly referred to as of the most common presenting problems in children psychoeducation (Lukens & McFarlane, 2004). Hoagwood is disruptive behavior (Garland et al., 2001). Many et al. (2010) identified components of effective first-line interventions for disruptive behavior problems psychoeducation-based programs, with components necessitate active parent engagement (e.g., parent including (a) education on the nature of child MH prob- management training; Hoagwood et al., 2010; Weisz & lems, (b) discussion of family factors impacting child Kazdin, 2010). Parent engagement is defined as con- MH, (c) clarification of the child’s need for services, sistent treatment attendance, active participation in and (d) education on the nature of treatment. Psycho- sessions, and adherence to treatment recommendations education has emerged as an evidence-based practice between sessions (Nock & Ferriter, 2005). However, across a variety of child MH interventions (Fristad, many families seeking services often encounter a range 2006; Lukens & McFarlane, 2004) and may be a power- of barriers to persistence in MH care, including both ful tool for addressing perceptual barriers to engaging structural barriers (e.g., access to providers, financial families, particularly families with low MH literacy. As issues, transportation problems) and perceptual barriers psychoeducation facilitates the comprehension of com- about MH problems and treatments (e.g., recognition of plex information, families receive optimistic messages MH needs, knowledge about treatments, stigma related about the treatability of child MH problems (Miklowitz to care; Owens et al., 2002). Knowledge and beliefs about & Goldstein, 1997). Parents are treated as partners in the nature of MH problems and effective treatments— treatment based on the assumption that the more referred to as MH literacy—appear to be among the knowledgeable the parent, the greater the chance of most common and explanatory barriers, and may limit positive child outcomes (Lukens & McFarlane, 2004). the use of evidence-based interventions (Jorm, 2000). Orienting and preparing families for treatment using Addressing
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